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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Dane County Parks Lyckberg Park <br /> OWtvER ADDRESS(Number,Bleat Oily,sat.,zip) El Deed Status;CUP; <br /> 5201 Fen Oak Or Ste 208,Madison WI 53718 D @ed Re8triCtlOn;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (608)267-3976 ciarke©alliantenergycenter.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and Includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> same as contractor La Crosse Sign Company ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2242 Mustang Way <br /> (City,Slate,Zip) (City,Sale,Zip) ❑Setbacks <br /> Madison,WI 53718 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 222-5353 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> teresak @lacrossesign.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dano.w3.us1) ❑Elevation of property <br /> PARENT P • LNUMBER: Cu'RENT ZON NG: ACREAGE: Elevation <br /> ❑PARCEL 251-0709.351-1215-5 TR-C1 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • City of Madison 35 14: NE 141 : NE ❑Driveway permits <br /> AGGRESS: (state,county,town) <br /> 102 Koster St <br /> CSM: LOT SUBDIVISION BLOCK/LOT ['Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION w, �fq>.� -x-t. <br /> PROJECT DESCRIPTION: '( <br /> Install ground sign NTE 32 sq ft/17 OAH b put`ii <br /> . 0 This project is a new building or structure. L 9 <br /> It d'.u <br /> ❑This project is an addition/alteration to an existing building or structure. -' '''',. e <br /> SANITARY SERVICE: PERMITNUMBER: �E-p ir7 , 'sppa a it a,` '-r-s� 1 <br /> DEv R rEPTIc t f.� 1�`+ - `��.. <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Not Including basement) —` Qz ,` ; <br /> 10.0 _X 1Ati ems;. . t, . <br /> AREA TO NEAREST SQUARE FOOT. � . ire`I t <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches) G f y � ; <br /> BASEMENT 1ST FLOOR: may}-' °J ll.�°� g .1.110.- ..-g.° <br /> 4,TOTAL SQUARE FOOTAGE: j t l '. ' <br /> 2ND FLOOR: 3RD FLOOR: A pp IIII : >:. Z ' <br /> ESTIMATED CONSTRUCTION COST: S �# ? i a `~ x <br /> (Please round to nearest dollar) —ta —• —4 .+ '--� .+ I $ 9,945.00 ,�ray ' `. 1 �F.-M <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes OVo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes o ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? :Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [)lo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) :Yes alo [(Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> 645412( (Continue on Back) -I, -► -I. <br />